Cognitive Behavioral Therapies & Practicum

1. Cognitive Behavioral Therapies & Practicum Course #39457 Current Professionals Track Substance Abuse Studies Training Program UNM Continuing Education

2. Behavior Therapy Behavior therapy is a method of counseling that focuses on modifying the patient’s learned behavior that are negatively affecting his or here life.

3. Cognitive Therapy Cognitive therapy holds that the principal determinant of emotions, motive and behavior is an individual’s thinking, which is a conscious process. Change perception, alter emotions = changes in lifestyle.

4. Classical Conditioning A model where a particular response to a stimuli can be elicited overtime by association with a related stimulus.

5. Unconditioned stimulus(UCS) A component of classical conditioning: an event that produces an unconditional response when present.

6. Unconditioned Response (UCR) A natural reaction to an unconditioned stimulus

7. Conditioned Response Aresponse that is identical to an unconditioned response, yet it is elicited by the conditioned stimulus, not the unconditioned stimulus.

8. Operant Conditioning This model is based on the theory that where behavior is reinforced and learned based on the consequences of the behavior.

9. Reinforcement Something that is added to a situation that increased the likelihood of that even or behavior of occurring again.

10. Negative Reinforcement Something that is taken away or removed from the situation that increase the likelihood of the behavior occurring again.

11. Modeling A principle where a behavior is learned by observing the consequences of someone else’s experience.

12. Shaping The procedure of rewarding successive approximations to the desired response.

13. Coping Skills TrainingInterpersonal Coping skills deficits are considered a major cause of drinking/using, which is likely to continue in the absence of adequate skills for coping with the events that trigger and follow us.

14. Introduction to Assertiveness Passive Aggressive Passive-aggressive Assertive See handout #1

15. Receiving Criticism about Drinking Type of Criticism • Constructive • Destructive See handout # 2

16. Refusal Skills • Learned in the CRA Class

17. Developing Social Support Network • There are many stresses associated with problem drinking and drug use. (relationships, illness, job loss, etc.) • Often, people who stop using still have friends who drink and use drugs. • Many people feel that drinking and using helps them to socialize. • See handout #3

18. Other Coping Skills • Communications skills • Nonverbal communications • Listening skills • Refusal skills • Resolving Relationship problems • See Monti et al., (2002)Treating Alcohol Dependence, Guilford Press.

19. Coping Skills TrainingIntrapersonal • Managing urges to drink/use • Problem solving (CRA) • Increasing pleasant activities (CRA) • Anger Management (CRA- FA) • Managing negative thinking • Seemingly irrelevant decisions • Planning for emergencies

20. Managing urges to drink/use • See handout #4 • Positive Thinking worksheet & • Urge control information sheet

21. Urge Control • Urges and Cravings are normal • They happen more in the early part of tx. • They have triggers, physical, environmental and psychological. • Urges are time Limited ******

22. Urge Control • Teach client to recognize triggers. • Exposure to cue • Watching others drinking or using • Contact with people, places, activities. • Elicit emotional states (anger, stress, etc) • Examine physical feelings (shakes, etc.)

23. Urge Control - Steps • Avoid identified urges • Find competing behaviors • Talk to a friend • Surf it (discuss urge surfing) • Challenge and change the thought • Review positive things since stopped using • Wait 15 minutes before you act • Use self talk. What is the worst that can happen?

24. Managing negative thinking • Triggers (event, person, place) • Thoughts (I can’t do this) • Feelings (Scared, depressed, angry) • How do you change each one of the above? • See handout #5

25. Seemingly irrelevant decisions • Many events are seemingly unrelated to a relapse but lead to one, Right? • What is a behavioral chain of events? • Can we change the outcome and where do we intervene?

26. Planning for emergencies • See handouts # 6 for exercise

28. ContingencyManagement • The theoretical foundation of CM was derived from principles of operant conditioning. • Behaviors are controlled by its consequences, and is amenable to change by altering its consequences.

29. Contingent • Dependent on something conditional • Something that may or may not happen.

30. ContingencyManagement • Patients are offered some attractive options, including tangible goods and services, immediately contingent on demonstrating objective evidence (i.e., drug-free urine samples).

31. Voucher Program • For every clean Urine, client gets monetary rewards • First drug-free urine = $2.50, each consecutive drug-free urine the amount given was increased by $1.50. • For every 3 consecutive drug-free urines the client received a $10.00 bonus. • In 12 weeks the client could earn up to $1000.00

32. Voucher Results • 75% of the clients who received the vouchers completed 24-weeks of abstinence compared to only 40% in the non-voucher group.

33. Implementing a Voucher Program • Describe the program to patients • Target Abstinence • One drug at a time works best • Set up a reinforcement schedule • Escalating pay • Reset the pay for non-compliance

34. Implementing a Voucher Program • Frequent Urine Monitoring • Provide Feedback • Minimizing delay in Voucher exchange • Frequent and regular voucher spending • Voucher Redemption • Abstinence Reinforcement Summary

35. Give examples of CM • Being on Probation? • Ultimatum from spouse? • Boss says next time you come in late your fired? • Condition of Probation is not going to bars? • How else can you use CM in your practice?

36. Behavioral Contracting • This is a means of scheduling reinforcements (verbal, behaviors, events) between two or more people.

37. Behavioral Contracting • Involve all relevant parties. • Write contracts, do not leave it to memory. • Have all parties sign the contract, which in effect is a review process. • Be sure contracts are understood by asking each party to describe what they have agreed to.

38. Behavioral Contracting • Role-Play the contact . • Clarify each parties responses. • There must be a benefit for each party. • No value judgments. • What is the pay-off or the desirable long term goal of the contract? • There should be some reinforcer sampling

39. Behavioral Contracting • There should be flexibility, if one party refuses an agreement suggest alternatives. • Always teach how to compromise. • Small agreements will lead to larger agreements. • You can build in sanctions for failure to follow through.

40. Behavioral Contracting • The therapist should eventually let the clients take the lead on making agreements. • Use positive wording making out contracts.

41. Behavioral Contracting Guide • Select one or two behaviors that you want to work on first. • Describe those behaviors so that they may be observed or measured. • Identify rewards that will help provide motivation to succeed. • Monitor or make sure someone monitors the contract and rewards success.

42. Behavioral Contracting • Write the contract so everyone understands it fully. • Troubleshoot if needed. • Rewrite the contract whether there is improvement or not. • Continue to monitor the contract over time. • Select new behaviors to work on.

43. Aversion Therapy • Aversion therapy attempts to interrupt the drinking behavior by creating a aversion or distaste for alcohol. • Alcohol is repeatedly paired with an US which is extremely unpleasant. That unpleasantness then generalized and becomes associated with alcohol.

44. Aversion Therapy • Alcohol is paired with drugs, electrical shock, imagery, smell or other very unpleasant stimulus. • Began in 1935 with injections of emetine, which cause nausea and vomiting. • Drank alcohol – injection = sick, sick, sick

45. Aversion Therapy • Aversion therapy has mixed results. • Some treatment centers won’t release their results. • Treatment (inpatient) usually lasts for 5, 30 minutes sessions with 2 booster sessions after discharge.

46. Aversion Therapy • There have been other drugs used including a curare like drug that actually caused total paralysis, including breathing. • Who’s next? Would you try it?

47. Aversion Therapy • Imageryand smell has been used as well with mixed results. The success rate varies from 50% maintaining abstinence to 9% remaining abstinent. Not used much anymore for obvious reasons.

48. Cue Exposure • CE is derived from learning and social learning theory models. • Cues can include sight, smells, places, people and emotional feelings (anger, stress, depressed, happy etc.). • Cues may play a role in resumption of using.

49. Cue Exposure • Since cues play an important part in triggering using behavior cue exposure training (CET) gives the client a chance to practice new coping skills to effectively handle those cues (triggers).

50. Cue Exposure • First, repeated exposure to a cue should result in habituation, (decreasing the strength of the cue). • Second, practice using coping skill in the presence of cues should make it easier to use them in a real situation.